Staging Systems
For many decades, doctors have been addressing the seriousness of particular cancers in terms of stages. Over the years, various staging systems have been developed to assist doctors in determining a diagnosis and the best form of treatment for the patient in question.
There are three popular staging systems used to examine the extent of mesothelioma. Each of the three different staging systems measure various factors of malignant mesothelioma including the extent of tumor or primary mass, the metastasis (spreading), and the involvement of the lymph nodes.
Butchart System
The Butchart System is the oldest staging system for malignant mesothelioma and is the one that is most commonly used by doctors and specialists to diagnose and treat malignant mesothelioma. The Butchart System is based on the tumor size (mass) and divides malignant mesothelioma into four stages:
- Stage 1 - Malignant mesothelioma has affected the right or left side of the chest cavity (pleura) and may be seen in the diaphragm.
- Stage 2 - Malignant mesothelioma has been found in the pleura on both sides of the body and may have also moved into the heart, stomach, or esophagus on both sides. Lymph nodes may be affected.
- Stage 3 - Malignant mesothelioma has reached the abdominal cavity (peritoneum). Lymph nodes past the chest may be affected.
- Stage 4 - Malignant mesothelioma has reached other organs and has entered the blood stream.
TNM System
The TNM System is a more modern staging system for malignant mesothelioma. The TNM System is based on the extent of the tumor, metastasis, and lymph node involvement. Again, the TNM System divides malignant mesothelioma into four stages:
- Stage 1 - Malignant mesothelioma is present in the left or right chest cavity (pleura) and may have metastasized to the lung, the sac around the heart (pericardium) or the diaphragm on the same side. Lymph nodes at Stage 1 are not involved.
- Stage 2 - Malignant mesothelioma has reached from one side of the chest cavity to a lymph node near the lung area on the same side as the cancer. The cancer has metastasized to the diaphragm, pericardium (sac around the heart) or the lung on the same side as the original cancer.
- Stage 3 - Malignant mesothelioma has penetrated the chest lining, heart, esophagus, muscle, ribs and vital organs within the chest cavity on the same side as the cancer. Lymph nodes may or may not be involved during this stage.
- Stage 4 - Malignant mesothelioma has metastasized to the pleural area and the lymph nodes on the opposite side of where the cancerous tumor is located. It may also have reached the chest cavities or lungs on both sides, or may have spread to the abdomen.
The Brigham System is the most modern of the three malignant mesothelioma staging systems. The Brigham System looks at different variables such as the involvement of the lymph nodes and the surgical ability to remove a malignant mesothelioma tumor (respectability). For this reason, it is often not used to stage mesothelioma as the cancer is rarely operable. The Brigham System divides malignant mesothelioma into four stages:
- Stage 1 - Malignant mesothelioma tumor is still resectable (able to be removed surgically) and the lymph nodes are not affected.
- Stage 2 - Malignant mesothelioma tumor is still resectable (able to be removed surgically) but the lymph nodes are now affected.
- Stage 3 - Malignant mesothelioma tumor is not resectable (able to be removed surgically) and the malignant mesothelioma has penetrated the heart, chest wall, abdominal cavity or diaphragm. Lymph nodes may or may not be affected.
- Stage 4 - Malignant mesothelioma tumor is not resectable (able to be removed surgically) and has completely metastasized (spread throughout the body).
When mesothelioma is diagnosed by a physician or specialist, they must determine the extent of the cancer and how far it has spread (metastasized). Most often, they will use imaging procedures to see inside the chest or abdomen to help determine the staging of the malignant mesothelioma. The imaging options your physician may use include:
Chest x-ray
CT scan of the chest and/or abdomen
MRI (Magnetic Resonance Imaging) scan of the chest and/or abdomen
PET (Positron Emission Tomography) scan of the chest and/or abdomen
Once the doctor is able to determine the stage of the mesothelioma, he/she will be able to formulate a plan for treatment and provide a prognosis.
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